Treitl Karla Maria, König Cosima, Reiser Maximilian F, Treitl Marcus
Hospitals of the Ludwig-Maximilians University of Munich, Germany
Hospitals of the Ludwig-Maximilians University of Munich, Germany.
J Endovasc Ther. 2015 Feb;22(1):63-70. doi: 10.1177/1526602814564363.
To prospectively assess current limitations and complication rates of the transbrachial access technique for endovascular treatment of peripheral vascular pathologies.
In total, 150 patients (112 men; mean age 66.3 ± 10.0 years) with arterial occlusive disease underwent endovascular therapy via a transbrachial access. Periprocedure data (sheath size, dose area product, fluoroscopy time, and procedure duration) were analyzed. Postprocedure complications of the puncture sites were categorized as minor (local hematoma, pseudoaneurysm, embolization, dissection, minor bleeding) and major (thrombotic occlusion, hematoma requiring surgery, major bleeding, nerve injury).
The minor and major complication rates were 14.0% (n = 21) and 2.7% (n = 4). The most frequent major complication was thrombotic occlusion of the brachial artery requiring surgical treatment (3/150, 2%). There was only one temporary palsy of the median nerve and no stroke. Local hematoma (15, 10%), pseudoaneurysm (3, 2%), or a combination of both (3, 2%) dominated the minor complications. The average dose area product and fluoroscopy time were 12,752.1 ± 9524.5 cGy*cm(2) and 24.3 ± 18.4 minutes, respectively, though procedure duration was acceptable (121.8 ± 48.9 minutes).
Complication rates of the transbrachial access for endovascular treatment of peripheral or visceral artery occlusive disease are tolerably low, making it a safe and an important alternative to the transfemoral access in selected cases, though the radiation exposure is rather high.
前瞻性评估经肱动脉入路技术在周围血管疾病血管内治疗中的当前局限性和并发症发生率。
总共150例患有动脉闭塞性疾病的患者（112例男性；平均年龄66.3±10.0岁）接受了经肱动脉入路的血管内治疗。分析围手术期数据（鞘管尺寸、剂量面积乘积、透视时间和手术持续时间）。穿刺部位的术后并发症分为轻微（局部血肿、假性动脉瘤、栓塞、夹层、轻微出血）和严重（血栓闭塞、需要手术的血肿、严重出血、神经损伤）。
轻微和严重并发症发生率分别为14.0%（n = 21）和2.7%（n = 4）。最常见的严重并发症是需要手术治疗的肱动脉血栓闭塞（3/150，2%）。仅有1例正中神经暂时麻痹，无中风发生。轻微并发症以局部血肿（15例，10%）、假性动脉瘤（3例，2%）或两者并存（3例，2%）为主。平均剂量面积乘积和透视时间分别为12,752.1±9524.5 cGy*cm(2)和24.3±18.4分钟，尽管手术持续时间可以接受（121.8±48.9分钟）。
经肱动脉入路用于周围或内脏动脉闭塞性疾病血管内治疗的并发症发生率较低，在某些特定情况下，尽管辐射暴露较高，但仍是一种安全且重要的股动脉入路替代方法。
